Public Health in The Gambia: The Impact of Policy and Privilege


Lamin E Kujabi

Public health in The Gambia is facing a significant crisis, characterized by poor availability, accessibility, acceptability, and quality of healthcare services. This situation is exacerbated by the stark disparity in healthcare access between the general population and the country’s policymakers and top government officials. The latter group often enjoys access to overseas treatment and private healthcare facilities, leading to a neglect of the public health system. This article argues that this privilege contributes significantly to the deteriorating state of public health in The Gambia, citing specific examples and the government’s failure to provide necessary medical equipment and facilities.

Availability of Healthcare Services

In The Gambia, the availability of healthcare services is critically limited. Many regions, particularly rural areas, suffer from a severe shortage of medical facilities and healthcare professionals. Policymakers and top government officials, who frequently seek treatment abroad or at private clinics, have little personal incentive to address these shortages. This lack of investment in the public health infrastructure leaves vast segments of the population without adequate healthcare services.

Accessibility of Healthcare Services

Healthcare accessibility in The Gambia is also severely compromised by geographic and financial barriers. The privileged elite, including policymakers and their families, can bypass these barriers by seeking treatment abroad or at private clinics. This leaves the majority of Gambians struggling to access the under-resourced public healthcare system. The disparity is stark: while the elite receive timely and high-quality care, the general population faces long wait times, travel burdens, and prohibitive costs.

Acceptability of Healthcare Services

Public health facilities in The Gambia often fail to meet acceptable standards of care. Poor conditions, long wait times, and inadequate patient care lead to widespread dissatisfaction and reluctance to seek treatment. Policymakers, who avoid these facilities in favor of private or overseas options, are not directly exposed to these issues. Consequently, there is a lack of urgency to improve the acceptability and patient experience in the public healthcare sector.

Quality of Healthcare Services

The quality of healthcare services in The Gambia’s public sector is a major concern. Public hospitals and clinics frequently face shortages of essential medicines, outdated equipment, and insufficiently trained staff. In contrast, private healthcare facilities, catering to the elite, offer superior resources and care standards. This two-tiered system ensures that those who can afford private care receive high-quality services, while the majority suffer the consequences of a neglected public health system.

Government Negligence and Rising Health Issues

The government’s failure to provide quality and adequate medical equipment and facilities has led to a significant rise in preventable deaths from conditions such as diabetes, hypertension, kidney failure, and maternal and child mortality.

Diabetes and Hypertension

The increasing mortality rates from diabetes and hypertension reflect the chronic neglect of preventive and primary healthcare services. Public health initiatives that could educate the population about lifestyle changes and provide regular screenings are underfunded and poorly implemented. In contrast, policymakers and their families, who have access to continuous and high-quality care, are insulated from these growing public health crises.

Kidney Failure

The rising cases of kidney failure point to inadequate access to specialized treatment and dialysis services in public hospitals. While private clinics offer these services at a premium, the majority of Gambians cannot afford them. Government officials, with their access to overseas treatment, do not experience the urgent need for improved local facilities.

Child Mortality and Maternal Mortality

Child mortality at birth and the mortality rate of women in labor are critical indicators of a failing public health system. Poor maternal healthcare services, lack of skilled birth attendants, and inadequate neonatal care contribute to these high mortality rates. Policymakers, whose families can seek superior care abroad, are often detached from these harsh realities, leading to insufficient investment in improving maternal and child health services.

Examples of Disparities

Several high-profile cases exemplify the disparities in healthcare access:

– The treatment of the Director General of the State Intelligence Service (SIS), Ousman Sowe , in Saudi Arabia.
– The wife of Ebrima Sillah, the Minister of Transport receiving medical care in Belgium few years ago.
– Numerous aides, advisers, ministers, managing directors, and director generals of state-owned enterprises who frequently travel abroad for medical treatment at the taxpayers’ expense.

These examples highlight the privilege enjoyed by the elite, who can access quality healthcare abroad while the majority of Gambians perish in dilapidated government healthcare facilities for treatable diseases.


The poor state of public health in The Gambia, characterized by inadequate availability, accessibility, acceptability, and quality of services, is significantly influenced by the actions and privileges of its policymakers and top government officials. Their reliance on overseas treatment and private healthcare facilities creates a disconnect from the needs of the general population, resulting in a lack of political will to address the systemic issues within the public health system. The rising death toll from chronic and preventable conditions underscores the urgent need for equitable healthcare reform. To address these issues, it is essential to foster accountability among the country’s leaders and promote substantial investment in the public healthcare infrastructure. Only through such measures can The Gambia hope to improve its public health outcomes and ensure that all citizens have access to the care they need.


Please enter your comment!
Please enter your name here